Arkansas Medicaid Appeals and Fair Hearings: How to Appeal

If your Arkansas Medicaid was denied, cut, or terminated, you have the right to appeal and request a fair hearing, and you can often keep your benefits while the appeal is decided.1,2 That right comes from federal Medicaid law, but Arkansas sets its own clock: the Arkansas Department of Human Services (DHS) Office of Appeals and Hearings must receive your written request within 30 calendar days of the date printed on your notice.3,4 To hold your coverage in place while you wait for a decision, you have to act even sooner, within 10 days, and ask in writing.3

In This Guide

• What You Can Appeal in Arkansas Medicaid
• Arkansas Medicaid Appeal Deadlines That Decide Your Case
• How to Keep Your Benefits During an Arkansas Medicaid Appeal
• Managed Care (PASSE) Appeals: Appeal Your Plan First
• How to Request a Fair Hearing in Arkansas
• Frequently Asked Questions

What You Can Appeal in Arkansas Medicaid

Federal law guarantees every Medicaid applicant and enrollee the right to a fair hearing before the state agency. Section 1902(a)(3) of the Social Security Act (42 USC 1396a(a)(3)) requires Arkansas's Medicaid plan to give a hearing to anyone whose claim for medical assistance is denied or is not acted on with reasonable promptness, and the implementing regulation at 42 CFR 431.220 extends that right to anyone who believes the agency acted erroneously or made an adverse determination.1

In Arkansas Medicaid, that right reaches across the program. You can appeal:

• An application denial (income, assets, household size, or citizenship and identity documentation)
• A termination or reduction of eligibility or covered services
• A renewal or recertification denial
• A prior-authorization denial or a level-of-care determination
• A PASSE managed-care plan's denial, reduction, suspension, or termination of a service

The same regulation that guarantees the hearing also covers managed-care members: 42 CFR 431.220 extends the right to any managed-care enrollee entitled to a hearing under the federal managed-care rules.1 What differs by situation is not whether you can appeal, but the deadline and the office that handles it.

Arkansas Medicaid Appeal Deadlines That Decide Your Case

Two deadlines govern an Arkansas appeal, and they are different numbers.

The request window is 30 calendar days. The DHS Office of Appeals and Hearings must receive your written hearing request within 30 calendar days of the date on your notice letter, or the request will be denied.3 Federal law under 42 CFR 431.221(d) sets the ceiling at 90 days from the date the notice is mailed, but a state may adopt a shorter operational window, and Arkansas uses 30 days.4 Read the date off your own notice and count from there, not from the day it reached your mailbox.

The continuation window is shorter, at 10 calendar days. That is the deadline that keeps your benefits flowing while the appeal is decided, and it is covered in the next section.

One more deadline protects renewals. If Arkansas ended your coverage only because you did not return a renewal form or requested information on time, you do not always have to reapply. Under 42 CFR 435.916, if you submit the renewal form or the missing information within 90 days after the termination date, the agency must reconsider your eligibility without a new application.5

How to Keep Your Benefits During an Arkansas Medicaid Appeal

Keeping your benefits during the appeal is called continuation, or "aid paid pending," and it is never automatic. You have to ask for it, and you have to ask in time.

Under the Arkansas rule, to keep your benefits in place while the appeal is decided, DHS must get your appeal letter within 10 calendar days of the date on the adverse-action notice, and in that letter you must specifically request that your benefits be continued.3 If you do both, your benefits continue until the appeal is over.

That instruction puts a federal rule into practice. Under 42 CFR 431.230(a), when the agency sends the required advance notice and you request the hearing before the date the action takes effect, the agency may not terminate or reduce your services until a decision is rendered after the hearing.2 Arkansas's 10-day instruction is how the state carries out that rule, so treat the earlier of the two dates on your notice as your real deadline.

Continued benefits carry one condition. If your benefits continue and the agency's decision is later upheld at the hearing, 42 CFR 431.230(b) permits the agency to recover the cost of the services it provided only because your benefits kept running.2 When an adverse-action notice arrives, get your appeal letter to DHS within 10 days and put your request to continue benefits in writing.

Managed Care (PASSE) Appeals: Appeal Your Plan First

Arkansas runs part of its Medicaid program through managed care. If you have complex behavioral-health needs or an intellectual or developmental disability, your care may run through a managed care organization (MCO) under the state's PASSE program (Provider-Led Arkansas Shared Savings Entity). As of 2026, the four participating PASSEs are Arkansas Total Care (ARTC), CareSource, Empower Healthcare Solutions, and Summit Community Care.3

When a PASSE denies, reduces, suspends, or ends a service, you appeal to the plan before you reach a state fair hearing.3 These steps come from the federal managed-care regulations at 42 CFR Part 438.

Under 42 CFR 438.404, the plan must give you timely, written notice of an adverse benefit determination, which includes a denial or limited authorization of a service, a reduction or termination of a previously authorized service, a denial of payment, or a failure to act within required timeframes. That notice must tell you how to appeal, how to request an expedited appeal, and how to ask that your benefits continue during the appeal.6

You have 60 calendar days from the date on the determination notice to file the plan's internal appeal, which you can request orally or in writing.7 The plan has only one level of appeal, and you must finish it before requesting a state fair hearing. Going straight to the hearing office without exhausting the plan's appeal gets the request dismissed.

The plan must resolve a standard appeal within 30 calendar days and an expedited appeal within 72 hours of receiving it. Either timeframe can be extended by up to 14 calendar days if you request the extension or the plan shows the state that more information is needed and the delay is in your interest.8 Ask for the 72-hour expedited track whenever waiting on the standard timeline could seriously jeopardize your life, health, or ability to regain function.

Once the PASSE upholds its decision, you have between 90 and 120 calendar days from the date of the plan's notice of resolution to request a state fair hearing, and the exact number within that band is set by the state.9 If the plan fails to meet the notice and timing rules, the appeal is deemed exhausted and you may go straight to a state fair hearing.6 A PASSE member can also contact the DHS PASSE Ombudsman for help working through the plan's process.3

How to Request a Fair Hearing in Arkansas

Arkansas Medicaid fair hearings are handled by the DHS Office of Appeals and Hearings, which conducts the administrative hearing and issues the final agency decision on appealed actions.3 To open a case, get your written request to that office within the 30-day window. You have three ways to file:

Whichever method you use, put the details in writing: your name, the decision you are appealing, the date on your notice, and, if you want to keep your benefits, a clear request that they be continued while the appeal is decided.3 Keep a copy of everything you send and the date you sent it, because the 30-day and 10-day clocks both run from the date on your notice.

Learn More

Find personalized help navigating an Arkansas Medicaid appeal at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.